MEDICARE: CHARIOT PITTSBURGH SNF OPCO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1952074759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARIOT PITTSBURGH SNF OPCO LLC

Provider Business Mailing Address
First Line	:	745 N HIGHLAND AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15206-2526
Country	:	US
Telephone Number	:	814-412-3626
Fax Number	:

Provider Business Practice Location Address
First Line	:	745 N HIGHLAND AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15206-2526
Country	:	US
Telephone Number	:	814-412-3626
Fax Number	:

Authorized Official
Title or Position	:	DIR PROVIDER CONTRACTING
Name	:	SHANA K MARK
Credential	:	MBA
Telephone Number	:	814-277-4500

Provider Enumeration Date	:	07/28/2021
Last Update Date	:	07/28/2021

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